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Transplant in ALL: who, when, and how? 移植:谁,何时,如何?
IF 2.9 3区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-12-06 DOI: 10.1182/hematology.2024000533
Curtis Marcoux, Partow Kebriaei

Allogeneic hematopoietic stem cell transplantation (allo-HCT) remains a cornerstone in the treatment of high-risk acute lymphoblastic leukemia (ALL), yet optimal patient selection is challenging in the era of rapidly changing modern therapy. Refined molecular characterization allows for better risk assessment, sparing low-risk patients from allo-HCT toxicity while identifying those who may benefit from intensified approaches. Measurable residual disease (MRD) has emerged as a powerful predictor of relapse irrespective of treatment strategy, challenging the necessity of transplant in MRD-negative patients. Further, expanded donor options, particularly haploidentical transplantation coupled with reduced intensity conditioning, have extended the applicability of allo-HCT to a broader range of patients. Finally, immunotherapies and targeted treatments are increasingly integrated into both initial and relapsed treatment protocols yielding deep remission and allowing for successful transplant in patients with a history of advanced disease. In this review, we provide an overview of the contemporary role of transplant in adult patients with ALL, focusing on indications for allo-HCT in first remission, optimal sequencing of transplant with novel therapies, and advancements in donor selection and conditioning regimens.

同种异体造血干细胞移植(allo-HCT)仍然是治疗高风险急性淋巴细胞白血病(ALL)的基石,但在快速变化的现代治疗时代,最佳患者选择是具有挑战性的。精细的分子表征允许更好的风险评估,使低风险患者免受同种异体hct毒性的影响,同时确定那些可能从强化方法中受益的患者。可测量残留病(MRD)已成为一个强大的复发预测指标,无论治疗策略如何,这对MRD阴性患者移植的必要性提出了挑战。此外,供体选择的扩大,特别是单倍体移植加上强度调节的降低,扩大了同种异体移植的适用性,使其适用于更广泛的患者。最后,免疫疗法和靶向治疗越来越多地整合到初始和复发治疗方案中,产生深度缓解,并允许有晚期疾病史的患者成功移植。在这篇综述中,我们概述了移植在成年ALL患者中的当代作用,重点是首次缓解时同种异体造血干细胞移植的适应症,新疗法移植的最佳测序,以及供体选择和调节方案的进展。
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引用次数: 0
Practical guide for disease-modifying medication management of children and adolescents with sickle cell disease. 儿童和青少年镰状细胞病改善疾病的药物管理实用指南。
IF 2.9 3区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-12-06 DOI: 10.1182/hematology.2024000587
Joseph Walden, Susan Creary

Hydroxyurea has historically been the sole disease-modifying medication (DMM) for sickle cell disease (SCD). However, 3 newer DMMs, L-glutamine, voxelotor, and crizanlizumab, were approved for children and adolescents with SCD since 2017. Despite their emergence, treatment barriers, including access, affordability, and nonadherence, limit the optimization of DMMs in the clinical setting. Furthermore, there is limited work outlining real-world use and safety of the newer DMMs, and no published guidelines advise how best to select between DMMs or to use multiple in combination. Meanwhile, each DMM is associated with unique characteristics, such as tolerability, cost, and route of administration, which must be considered when weighing these options with patients and families. This article discusses DMMs for SCD and offers practical guidance on using the available DMMs in real-world settings based on published peer-reviewed studies and considering patient preferences. The recent withdrawal of one of these DMMs (voxelotor) from the market highlights the need for additional DMMs and evidence-based practices for adding DMMs and when to progress towards curative therapies.

羟基脲历来是镰状细胞病(SCD)唯一的疾病改善药物(DMM)。然而,自2017年以来,3种新的dmm (L-glutamine, voxelotor和crizanlizumab)被批准用于儿童和青少年SCD。尽管它们出现了,但治疗障碍,包括可获得性、可负担性和不依从性,限制了临床环境中dmm的优化。此外,关于新dmm的实际使用和安全性的概述工作有限,并且没有发布的指南建议如何在dmm之间进行最佳选择或组合使用多种dmm。同时,每种DMM都具有独特的特征,如耐受性、成本和给药途径,在与患者和家属权衡这些选择时必须考虑这些特征。本文讨论了SCD的dmm,并根据已发表的同行评审研究和考虑患者偏好,提供了在现实环境中使用可用dmm的实用指导。最近,其中一种dmm (voxelotor)从市场上退出,这突出表明需要更多的dmm和添加dmm的循证实践,以及何时向治疗性治疗进展。
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引用次数: 0
Quantifying menorrhagia and overview of nonsurgical management of heavy menstrual bleeding. 月经过多的量化和大量月经出血的非手术治疗综述。
IF 2.9 3区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-12-06 DOI: 10.1182/hematology.2024000661
Allison P Wheeler, Celeste O Hemingway

Heavy menstrual bleeding (HMB) is a common problem, presenting in 1 in 5 females. The quantification of menstrual blood loss and the subsequent treatment of HMB are both nuanced tasks that require the physician to consider the patient perspective. The individualization of care and transition to methods that fit each individual patient are critical to building a successful relationship with the patient to facilitate follow-up care and evaluation of response to treatment. In this review we outline various methods of quantification of menstrual blood loss, including considerations of accuracy and practicality. These methods, all of which have the potential for clinical benefit, vary from pictorial assessment charts to the gold standard alkaline hematin method to asking the patient about their average amount of blood loss and how it affects their quality of life. Next, we outline nonsurgical treatments for HMB, including hormonal and nonhormonal options, and consider the potential for success, as well as treatment considerations and contraindications. Overall, options for the evaluation and nonsurgical management of menstrual blood loss and HMB are presented along with quality-of-life considerations.

月经大出血(HMB)是一个常见的问题,出现在五分之一的女性中。经血损失的量化和HMB的后续治疗都是细致入微的任务,需要医生考虑患者的观点。护理的个体化和过渡到适合每个病人的方法是与病人建立成功关系的关键,以促进后续护理和评估对治疗的反应。在这篇综述中,我们概述了各种量化月经失血的方法,包括准确性和实用性的考虑。这些方法都有潜在的临床益处,从图像评估图表到金标准碱性血素法,再到询问患者的平均失血量及其对生活质量的影响,不一而足。接下来,我们概述了HMB的非手术治疗,包括激素和非激素的选择,并考虑成功的可能性,以及治疗注意事项和禁忌症。总的来说,评估和非手术管理的选择月经失血和HMB提出与生活质量的考虑。
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引用次数: 0
Sequencing bispecific antibodies and CAR T cells for FL. FL的双特异性抗体和CAR - T细胞测序。
IF 2.9 3区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-12-06 DOI: 10.1182/hematology.2024000667
David A Russler-Germain, Nancy L Bartlett

Treatment for relapsed/refractory (R/R) follicular lymphoma (FL) has evolved over recent years with the introduction of multiple novel immunotherapies: anti-CD3  ×  CD20 bispecific antibody (BsAb) T-cell engagers and anti-CD19 chimeric antigen receptor T cells (CAR T). Both drug classes are highly active, and their adverse event profiles overlap considerably, with cytokine release syndrome, cytopenias, and infections being most common. However, key differences include accessibility and logistical considerations as well as distinct neurologic toxicities, which make recommending a BsAb or CAR T a nuanced decision for each patient with R/R FL. Notably, patients could receive both classes of therapies in sequence; however, data guiding this decision are sparse. Considering the 3 most advanced agents in each class, we generally favor BsAbs before CAR T as the standard-of-care third-line treatment for the typical patient with R/R FL without concern for aggressive histologic transformation (HT). This is based on a 3-year follow-up of the mosunetuzumab phase 2 trial in R/R FL highlighting durable complete responses after a time-limited therapy with an acceptable safety profile for patients of all ages and reasonable performance status. We generally prioritize CAR T before BsAbs for patients with proven or suspected HT given the curative-potential of this approach based on trial data from R/R diffuse large B-cell lymphoma; it is unknown whether BsAbs offer the same long-term benefit in transformed FL. Overall, with the ability to personalize the sequencing of BsAbs and CAR T, the recently expanding portfolio of highly effective immunotherapies for R/R FL is poised to offer considerable benefit to this patient population.

近年来,随着多种新型免疫疗法的引入,复发/难治性(R/R)滤泡性淋巴瘤(FL)的治疗不断发展:抗cd3 × CD20双特异性抗体(BsAb) T细胞结合剂和抗cd19嵌合抗原受体T细胞(CAR - T)。这两种药物都具有高活性,其不良事件特征有很大的重叠,细胞因子释放综合征、细胞减少和感染是最常见的。然而,关键的差异包括可及性和后勤考虑以及不同的神经毒性,这使得推荐BsAb或CAR - T对每个R/R FL患者来说是一个微妙的决定。值得注意的是,患者可以依次接受这两类治疗;然而,指导这一决策的数据很少。考虑到每个类别中3种最先进的药物,我们通常倾向于在CAR - T之前使用bsab作为典型R/R FL患者的标准护理三线治疗,而无需考虑侵袭性组织学转化(HT)。这是基于对R/R FL的mosunetuzumab 2期试验的3年随访,强调在有限的时间治疗后持续完全缓解,对所有年龄的患者和合理的表现状态具有可接受的安全性。基于R/R弥漫性大b细胞淋巴瘤的试验数据,鉴于CAR - T疗法的治疗潜力,我们通常优先考虑CAR - T疗法,而不是bsab疗法。目前尚不清楚bsab是否能在转化的FL中提供相同的长期益处。总的来说,由于bsab和CAR - T的个性化测序能力,最近扩大的R/R FL高效免疫疗法组合有望为这一患者群体提供可观的益处。
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引用次数: 0
Diagnosis and management of hereditary hemochromatosis: lifestyle modification, phlebotomy, and blood donation. 遗传性血色素沉着症的诊断和治疗:改变生活方式、采血和献血。
IF 2.9 3区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-12-06 DOI: 10.1182/hematology.2024000568
Domenico Girelli, Giacomo Marchi, Fabiana Busti

The term hemochromatosis refers to a group of genetic disorders characterized by hepcidin insufficiency in the context of normal erythropoiesis, iron hyperabsorption, and expansion of the plasma iron pool with increased transferrin saturation, the diagnostic hallmark of the disease. This results in the formation of toxic non-transferrin-bound iron, which ultimately accumulates in multiple organs, including the liver, heart, endocrine glands, and joints. The most common form is HFE-hemochromatosis (HFE-H) due to p.Cys282Tyr (C282Y) homozygosity, present in nearly 1 in 200 people of Northern European descent but characterized by low penetrance, particularly in females. Genetic and lifestyle cofactors (especially alcohol and dysmetabolic features) significantly modulate clinical expression so that HFE-H can be considered a multifactorial disease. Nowadays, HFE-H is mostly diagnosed before organ damage and is easily treated by phlebotomy, with an excellent prognosis. After iron depletion, maintenance phlebotomy can be usefully transformed into a blood donation program. Lifestyle changes are important for management. Non-HFE-H, much rarer but highly penetrant, may lead to early and severe heart, liver, and endocrine complications. Managing severe hemochromatosis requires a comprehensive approach optimally provided by consultation with specialized centers. In clinical practice, a proper diagnostic approach is paramount for patients referred for hyperferritinemia, a frequent finding that reflects hemochromatosis only in a minority of cases.

血色素沉着症是指一组遗传性疾病,其特征是在红细胞生成正常、铁吸收高、血浆铁池扩张伴转铁蛋白饱和度升高的情况下,出现hepcidin不足,这是该疾病的诊断标志。这导致形成有毒的非转铁蛋白结合铁,最终积聚在多个器官,包括肝脏、心脏、内分泌腺和关节。最常见的形式是hfe -血色素沉着症(HFE-H),由于p.Cys282Tyr (C282Y)纯合性,在北欧血统的200人中有近1人存在,但其特点是外显率低,特别是在女性中。遗传和生活方式辅助因素(尤其是酒精和代谢异常特征)显著调节临床表达,因此HFE-H可被认为是一种多因素疾病。目前,HFE-H多在器官损害前诊断,且易于通过放血治疗,预后良好。铁耗尽后,维持性放血可以有效地转化为献血计划。生活方式的改变对管理很重要。非hfe - h非常罕见,但渗透性高,可能导致早期和严重的心脏、肝脏和内分泌并发症。管理严重血色素沉着症需要一个全面的方法,最好提供咨询专业中心。在临床实践中,正确的诊断方法对于高铁蛋白血症患者至关重要,高铁蛋白血症是一种常见的发现,仅在少数病例中反映血色素沉着症。
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引用次数: 0
Has PD-1 blockade changed the standard of care for cHL? PD-1阻断是否改变了cHL的治疗标准?
IF 2.9 3区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-12-06 DOI: 10.1182/hematology.2024000574
Thomas M Kuczmarski, Ryan C Lynch

The treatment paradigm for classic Hodgkin lymphoma (CHL) continues to evolve, particularly in light of the incorporation of programmed cell death protein 1 (PD-1) inhibitors into a variety of therapeutic settings. PD-1 inhibitors have demonstrated high efficacy and a favorable toxicity profile when added to a doxorubicin, vinblastine, dacarbazine chemotherapy backbone in patients with untreated CHL. PD-1 inhibitors are also effective treatment options in the relapsed/refractory setting. For patients who are pursuing autologous stem cell transplant (ASCT), pembrolizumab plus gemcitabine, vinorelbine, and liposomal doxorubicin has shown marked efficacy and is an effective treatment regimen to administer prior to transplant. For patients who either are not eligible for ASCT or have relapsed after ASCT, pembrolizumab or nivolumab monotherapy have been well studied and demonstrate high efficacy even when patients have been exposed to numerous lines of prior therapy. As data from previous trials continue to mature and new clinical trials are conducted, PD-1 inhibitors will continue to become an integral component for successful management of CHL.

经典霍奇金淋巴瘤(CHL)的治疗模式继续发展,特别是考虑到将程序性细胞死亡蛋白1 (PD-1)抑制剂结合到各种治疗环境中。PD-1抑制剂在未经治疗的CHL患者中加入阿霉素、长春花碱、达卡巴嗪化疗后显示出高疗效和良好的毒性。PD-1抑制剂也是复发/难治性疾病的有效治疗选择。对于正在进行自体干细胞移植(ASCT)的患者,派姆单抗联合吉西他滨、维诺瑞滨和阿霉素脂质体已显示出显著的疗效,是移植前有效的治疗方案。对于不符合ASCT条件或ASCT后复发的患者,pembrolizumab或nivolumab单药治疗已经得到了很好的研究,即使患者已经接受过多种先前治疗,也显示出很高的疗效。随着以往试验数据的不断成熟和新的临床试验的开展,PD-1抑制剂将继续成为成功治疗CHL不可或缺的组成部分。
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引用次数: 0
Luspatercept: a treatment for ineffective erythropoiesis in thalassemia. Luspatercept:一种治疗地中海贫血无效红细胞生成的药物。
IF 2.9 3区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-12-06 DOI: 10.1182/hematology.2024000567
Khaled M Musallam, Ali T Taher

Patients with β-thalassemia continue to have several unmet needs. In non-transfusion-dependent patients, untreated ineffective erythropoiesis and anemia have been associated with a variety of clinical sequelae, with no treatment currently available beyond supportive transfusions. In transfusion-dependent forms, lifelong transfusion and iron chelation therapy are associated with considerable clinical, psychological, and economic burden on the patient and health care system. Luspatercept is a novel disease-modifying agent targeting ineffective erythropoiesis that became recently available for patients with β-thalassemia. Data from randomized clinical trials confirmed its efficacy and safety in reducing transfusion burden in transfusion-dependent patients and increasing total hemoglobin level in non-transfusion-dependent patients. Secondary clinical benefits in patient-reported outcomes and iron overload were also observed on long-term therapy, and further data from real-world evidence studies are awaited.

β-地中海贫血患者仍有若干需求未得到满足。在非输血依赖患者中,未经治疗的无效红细胞生成和贫血与各种临床后遗症有关,目前除了支持性输血外没有其他治疗方法。在依赖输血的形式中,终身输血和铁螯合治疗会给患者和卫生保健系统带来相当大的临床、心理和经济负担。Luspatercept是一种针对无效红细胞生成的新型疾病调节剂,最近可用于β-地中海贫血患者。随机临床试验数据证实了其在减轻输血依赖患者输血负担和提高非输血依赖患者总血红蛋白水平方面的有效性和安全性。长期治疗还观察到患者报告的结果和铁超载的次要临床益处,并等待来自实际证据研究的进一步数据。
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引用次数: 0
Transfusions, disease-modifying treatments, and curative therapies for sickle cell anemia in Africa: where are we now? 非洲镰状细胞性贫血的输血、疾病改善治疗和治愈性治疗:我们现在在哪里?
IF 2.9 3区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-12-06 DOI: 10.1182/hematology.2024000550
Isaac Odame, Godwin Nosakhare Bazuaye

The mortality burden of sickle cell anemia (SCA) is centered in sub-Saharan Africa. In addition to a lack of systematic programs for early diagnosis, access to disease-modifying treatments is limited to only a few urban centers. Providing a safe and adequate blood supply is a major challenge, heightening mortality from SCA-associated complications that require urgent blood transfusion and making the delivery of regular transfusion therapy for stroke prevention nonfeasible. Hydroxyurea therapy with proven clinical benefits for pain episodes, acute chest syndrome, malaria, transfusions, hospitalizations, and stroke prevention is the most feasible treatment for SCA in Africa. Access barriers to hydroxyurea treatment include poor availability, unaffordable costs, health professionals' reluctance to prescribe, a lack of national guidelines, and exaggerated fears about drug toxicities. Strategies for the local manufacture of hydroxyurea combined with the systematic education and training of health professionals using guidelines supported by the World Health Organization can help surmount the access barriers. Hematopoietic stem cell transplantation as a curative therapy is available in only 7 countries in Africa. The few patients who have suitable sibling donors and can afford a transplant must usually travel out of the country for treatment, returning to their home countries where expertise and resources for posttransplant follow-up are lacking. The recently developed ex-vivo gene therapies are heavily dependent on technical infrastructure to deliver, a daunting challenge for Africa. Future in-vivo gene therapies that bypass myeloablation and ex-vivo processing would be more suitable. However, enthusiasm for pursuing these gene therapies should not overlook strategies to make hydroxyurea universally accessible in Africa.

镰状细胞性贫血(SCA)的死亡率负担主要集中在撒哈拉以南非洲。除了缺乏系统的早期诊断方案外,只有少数城市中心才有机会获得改善疾病的治疗。提供安全和充足的血液供应是一项重大挑战,这增加了sca相关并发症的死亡率,这些并发症需要紧急输血,并使为预防卒中提供定期输血治疗变得不可行的。羟基脲治疗在疼痛发作、急性胸综合征、疟疾、输血、住院和中风预防方面具有临床证实的益处,是非洲SCA最可行的治疗方法。获得羟基脲治疗的障碍包括可获得性差、费用负担不起、卫生专业人员不愿开处方、缺乏国家指南以及对药物毒性的夸大担忧。当地生产羟基脲的战略,加上使用世界卫生组织支持的准则对卫生专业人员进行系统的教育和培训,可以帮助克服获取障碍。造血干细胞移植作为一种治疗性疗法仅在非洲7个国家可用。少数有合适的兄弟姐妹供体并能负担得起移植费用的患者通常必须出国治疗,回到缺乏移植后随访的专业知识和资源的祖国。最近开发的离体基因疗法严重依赖技术基础设施来提供,这对非洲来说是一个艰巨的挑战。未来绕过骨髓消融和离体处理的体内基因治疗将更为合适。然而,追求这些基因疗法的热情不应忽视使羟基脲在非洲普遍可及的战略。
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引用次数: 0
Treatment of VTE in the thrombocytopenic cancer patient. 血小板减少性癌症患者静脉血栓栓塞的治疗。
IF 2.9 3区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-12-06 DOI: 10.1182/hematology.2024000551
Florian Moik, Cihan Ay

Thrombocytopenia is a frequent complication in patients with cancer, mostly due to the myelosuppressive effects of antineoplastic therapies. The risk of venous thromboembolism (VTE) in patients with cancer is increased despite low platelet counts. The management of cancer-associated VTE in patients with thrombocytopenia is challenging, as the risk of both recurrent VTE and bleeding complications is high. Moreover, the time-dependent nature of thrombocytopenia over the course of antineoplastic therapies further complicates the management of patients in clinical practice. In the absence of evidence from high-quality studies, the management of anticoagulation therapy for VTE must be personalized, balancing the individual risk of VTE progression and recurrence against the risk of hemorrhage. In the present case-based review, we highlight the clinical challenges that arise upon managing cancer-associated VTE in the setting of present or anticipated thrombocytopenia, summarize the available evidence, and provide a comparative overview of available guidelines.

血小板减少症是癌症患者常见的并发症,主要是由于抗肿瘤治疗的骨髓抑制作用。尽管血小板计数低,但癌症患者静脉血栓栓塞(VTE)的风险增加。由于静脉血栓栓塞复发和出血并发症的风险很高,治疗血小板减少患者的癌症相关性静脉血栓栓塞具有挑战性。此外,血小板减少症在抗肿瘤治疗过程中的时间依赖性进一步复杂化了患者在临床实践中的管理。在缺乏高质量研究证据的情况下,静脉血栓栓塞的抗凝治疗管理必须个性化,平衡静脉血栓栓塞进展和复发的个体风险与出血风险。在目前基于病例的回顾中,我们强调了在现有或预期的血小板减少的情况下管理癌症相关静脉血栓栓塞所面临的临床挑战,总结了现有的证据,并提供了现有指南的比较概述。
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引用次数: 0
Troubleshooting heparin resistance. 排除肝素耐药性。
IF 2.9 3区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-12-06 DOI: 10.1182/hematology.2024000659
Cheryl L Maier, Jean M Connors, Jerrold H Levy

The term heparin resistance is likely best defined as the failure of an appropriate dose of unfractionated heparin (UFH) to achieve a predetermined level of anticoagulation. Unfortunately, and despite many prior reports, there is no established consensus as to what either the appropriate dose or the predetermined level should be. Traditionally, assays used to monitor anticoagulation with UFH have been clot based, including the activated partial thromboplastin time, used for patients on the ward or intensive care unit, and the activated clotting time, used for patients undergoing vascular interventions and cardiopulmonary bypass. Unfortunately, these tests may be highly influenced by other factors occurring in many patients, especially those with inflammation or acute infection, as noted during the COVID-19 pandemic. Many hospitals have thus moved to anti-Xa testing for heparin monitoring. Another important factor in defining heparin resistance includes dosing, whether weight-based or total daily dosing is used, as initial reports of heparin resistance described daily doses independent of body weight. Multiple causes of apparent heparin resistance include hypercoagulability, antithrombin deficiency, andexanet alfa used for direct oral anticoagulant reversal, thrombocytosis, and antiphospholipid antibody syndromes. Treatment options for managing patients with heparin resistance include weight-based dosing and administration of additional UFH, antithrombin supplementation, or the use of an alternative anticoagulant such as the direct thrombin inhibitors bivalirudin or argatroban.

肝素耐药一词最好的定义可能是适当剂量的未分离肝素(UFH)未能达到预定的抗凝水平。不幸的是,尽管以前有许多报告,但对于适当的剂量或预定的水平应该是多少,并没有确定的共识。传统上,用于监测UFH抗凝的检测是基于凝块的,包括用于病房或重症监护病房患者的活化部分凝血酶活时间,以及用于接受血管干预和体外循环的患者的活化凝血时间。不幸的是,正如COVID-19大流行期间所指出的那样,这些检测可能会受到许多患者,特别是炎症或急性感染患者的其他因素的高度影响。因此,许多医院已经转向肝素监测的抗xa检测。定义肝素耐药的另一个重要因素包括剂量,无论是基于体重还是每日总剂量,因为肝素耐药的初步报告描述的是与体重无关的每日剂量。明显肝素耐药的多种原因包括高凝性、抗凝血酶缺乏、用于直接口服抗凝逆转、血小板增多和抗磷脂抗体综合征的德沙奈。管理肝素耐药患者的治疗选择包括基于体重的给药和额外的UFH,抗凝血酶补充,或使用替代抗凝血剂,如直接凝血酶抑制剂比伐鲁定或阿加曲班。
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引用次数: 0
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Hematology. American Society of Hematology. Education Program
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